10 Day Habit Refresh
Day Four: Bite Sizes & Speed
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Three questions we’ll answer about each habit in this series
In this series I will answer three questions about each of the habits:
What benefit does this habit bring a post-op patient?
How might the lack of this habit effect a post-op patient?
How can you best build up this habit in the post-op daily life?
What benefit does small bites and eating slowly bring a post-op patient?
If you read or listened to yesterdays post (link here to catchup) you might have noticed my hinting at how bite sizes and speed would be connected to focusing on solid protein.
We in the bariatric world often refer to bite sizes and speed as eating behaviors.
Eating behaviors are the actual actions around how the food is eaten. The speed of eating, the length of chewing, the point of stopping. These are the behaviors associated with a meal time.
(Although in my house the behaviors around eating include two small children that struggle to sit in a chair very long. I feel like ability to sit in a chair should also be related to an eating behavior!)
If a patient is not tolerating a food, the dietitian will likely ask more questions to identify if the issue is related to the food itself or the eating behavior of the meal.
But let’s be honest. These habits are really tough. In an effort to focus on the positive first, let’s talk through how ideal bariatric eating behaviors will benefit a post-op patient.
Bariatric Sized Bites
Arguably one of the hardest eating behaviors a post-op will need after surgery is to eat tiny bites.
It does go against what feels normal and natural about eating a meal. Many patients will buy smaller forks and realize just how large our forks are as humans!
You’ll hear bariatric dietitians give all sorts of visuals for what size of a bite you should aim for. The trick is also to listen to your pouch for yourself. In my years of practice my colleagues and I would use a black bean as a visual or sometimes your pinkie finger nail for a visual that you have on hand (pun intended.)
Yes. It is super weird.
It all has to do with the stoma or the opening of your stomach after surgery. The surgeons are all smarter than me and would be better able to explain the size of the pouch they create, but nonetheless we all know they made the stomach small.
Getting something large into something that is small is going to create some commotion.
Surgeons I worked for in the past have used a highlighter marker as a visual for the opening into a post-op stomach. Whether this is a perfect example or not, it reminds us that a bite that is too big trying to get into small opening (the marker cap) will cause back up and/or discomfort.
A patient who takes small bites (pencil eraser, black bean, pinkie nail) will be providing food in the appropriate size to get into the small pouch. They will tolerate food (especially solid protein) more easily and feel less confusion on when to stop eating.
This means they can fill up on that filling, solid protein and identify their stopping point. This helps with portion control and hunger control.
Speed of eating
Connected to the bite size is the speed at which the bites are eating.
Going back to the highlighter marker, even if the bites are very small if they are eaten quickly back to back it can cause a backup as well. It can also make it confusing to identify when to stop eating because possibly the last bite you needed was on its way down but another bite is following quickly behind it.
A patient who spaces out their bites will be better able to identify their natural stopping point.
Some programs may give a guideline on how long to wait in between bites. My go-to recommendation here is to put your fork down in between each bite and ask yourself how you feel.
Meal times are ideally 20-30 minutes. If you are early post-op you may find you can’t make a meal last 20 minutes! You’ll get there. It does take about that long for the brain to identify fullness. Another reason why eating too fast means overeating.
If someone is taking more than 30 minutes that can turn into a grazing pattern and the first bite may be on its way out of the pouch but more bites are slowly coming. This makes it harder to know the true portion size.
Quick side note: many programs and patients will put an emphasis on chewing well. While this certainly important, I would prefer the emphasis be put on the size of the bite itself. A large bite that is chewed 100 times will still hit too heavy if it is too big. Small bites are often chewed enough because it doesn’t take as much time to chew if it’s less food.
How might the lack of this habit effect a post-op patient?
Once again we are acknowledging that small bites and eating slowly is way, way easier said than done. I get you.
This is one of those habits that patients often have to get back to. It’s worth getting back to and don’t feel badly if you find yourself needing to course correct, again.
When I was counseling patients all day every day (before I was able to work full time on this website!) I bet I talked about bite sizes and speed with 70% of my appointments.
The times when someone was doing well with it, they often had little to no trouble staying on track with their diet.
Compared to the times when someone was really struggling with it, their food choices were all over the place. It’s a super powerful habit for better or worse.
For the patient that is having too large of bites and/or eating too quickly they are often experiencing pre-mature fullness. They think they are full or need to stop, but find themselves hungry an hour or two later.
This causes trouble with snacking which creates more grazing or more hunger issues throughout the day. If those snacks are also higher in carbohydrates, the hunger is only stronger. When a patient tells me they are hungry all day, the first thing we dial into is the bite size and speed.
Many patients start to gravitate away from solid protein (as discussed yesterday) making it harder to have restriction and hunger control from their meals. They may have food aversions (strong dislike) of solid protein if meat is causing a lot of issues. We can often times course correct with eating behaviors!
How can you best build this habit in the post-op life?
Don’t give up trying to get back to eating your meals with bariatric habits.
Many patients like cocktail forks (small forks) because it’s hard to take a large bite on a tiny fork.
Many others like the timer inside the Baritastic app (by the way, if you use Baritastic you may notice tons of the recipes in there are mine!)
My other tip is to cut all your food up before you start eating. If you tend to get distracted (ME) this helps big time.
Here’s my second remind in this series that no patient will get all of these habits perfect. It’s good to know what they are, why they are and how you can build them up. If you can do a lot of these things, pretty well, most of the time that will serve you better than expecting more of yourself and giving up!